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Doctors’ Sensitization

Doctors’ Sensitization

News of assault on doctors is becoming common, in fact a new norm. Violence is due to a more demanding and aggressive society, fueled by politicalization and criminalization. . The image of the doctors’ has also suffered a beating due to various causes.  There is no deterrence against the hooligans. Poor conviction rates and political patronage to anti-social elements decrease restraint. However, little do these VIPs know that disrespect to the doctor affects the safety of the patient and a good outcome is pushed away?

Violence or assault on doctors is defined by the WHO as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation”. Violent acts can be: physical, sexual, psychological and emotional. What can lead to assault? Sudden death, denial of admission, denial of false medical certificates or false bills, delay in providing care, shortages of drugs, manpower, and equipments or ambulance, negligence by staff, political or social goonda-ism, perceived unethical practices or hurt of ego and intolerance etc. On the hospital sides the reason may be: Poor infrastructure, Irritated doctor, long hours and fatigue, shift duties, uncertain future, overworked, inadequate compensation as compared to colleagues in other professions. Misbehavior by junior doctors or paramedical staff can be another reason. The net effect is increased cost of services and decreased trust in the doctor – patient relationship. Empathy helps prevent violence. Cure where possible, care always and communicate maximum. Poor prognosis cases need to be explained by senior doctors. Public has to appreciate the difference between complication, negligence, and wrong intent. Doctor is not guarantor of life!

Attendant’s Rudeness: Threat to Patient’s safety

A working group on professionalism from Harvard Medical School has suggested that disrespect is pervasive in health care and constitutes a widespread threat to the safety and well-being of patients and health care workers. They argue that disrespectful treatment to patients and their kin is “so common and so intimately woven into the health care environment and everyday work that they are accepted as normal and often are not recognized as disrespect.” As examples, they cite long work hours, high workloads, physical hazards, and psychological intimidation that affect doctors, nurses and all health professionals. Taken together, these increase the likelihood that staff will make errors that harm patients or themselves, and diminish meaning or satisfaction in their daily work. As far as patients are concerned, disrespect manifests itself as “being made to wait for appointments, receiving patronizing and dismissive answers to questions, not being given full and honest disclosure when things go wrong, and not receiving the information they need to make informed decisions.” It is proposed that a culture of respect for the hospital staff is a precondition for the changes needed to make health care safe.

 

A clinical trial on ‘rudeness’ conducted recently in Israel has been widely reported. Twenty-four neonatal intensive care teams participated in a training simulation exercise, centered on a preterm infant with necrotising enterocolitis who was deteriorating. Participants were told that a foreign expert on teamwork would observe them working together. Teams were then randomly assigned to two groups. One group first listened to a recorded message from the expert, who made rude comments about the quality of medicine in Israel. A control group heard a different, neutral message from the same expert, who made no rude comments. The authors of the study concluded ‘rudeness may have an adverse effect’ on cognitive performance, leading to impaired diagnostic thinking and dexterity, as well as reducing the collaboration needed for good care. They wrote: “rude behaviors regularly experienced by medical practitioners”, seemingly benign, can result in “potentially devastating outcomes” for patients. Doctors who have experienced bullying are more likely to report having made serious medical mistakes. Medical students who were bullied during their training are more likely to mistreat patients in their turn. Negative behavior arises not only because of individuals who are deviant or under exceptional stress. More commonly, it happens when whole groups, teams or institutions develop a negative culture.

The Harvard working group makes comparisons with so-called “high-reliability organizations” like those in the aviation and nuclear power industries, where everyone understands that small failures can lead to catastrophic outcomes. Such organizations emphasize the relational aspects of culture viz. person-centeredness, support for co-workers, friendliness, openness in personal relations, creativity, trust and resilience. The task of changing the culture of medicine in this direction, the Harvard team argues, must start with medical colleges. Leaders need to engage frontline workers by ensuring safe, simple and productive reporting systems, together with prompt, predictable and appropriate responses. The authors emphasize: “The time has come for health care organizations to do something about this invidious problem and cultivate a climate of respect.” Public in general has also to approach the doctor with a degree of respect and sophistication.

There are two further perspectives that need to be considered when addressing rudeness and disrespect. One is that of ethics and the other is political. From the point of view of ethics, each one of personnel is capable of rudeness, causing offence to colleagues or patients. It requires moral courage to apologize and change one’s speech and actions accordingly. Looking from the perspective of politics, health services are influenced by norms in the society around them. When a society operates through confrontation and aggressive talk, it becomes proportionately more difficult for medical organizations to foster respect, or for individual health workers to express their capacity for kindness. Tackling rudeness and disrespect properly may require contrition both on a personal level, and at a political one.

 

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